Graphical Abstract:

Abstract:

Objective: We evaluated the effectiveness of Electroconvulsive Therapy (ECT) in the
treatment of Bipolar Disorder (BD) in a large sample of bipolar patients with drug resistant depression,
mania, mixed state and catatonic features.

Method: 522 consecutive patients with DSM-IV-TR BD were evaluated prior to and after the ECT course.
Responders and nonresponders were compared in subsamples of depressed and mixed patients.
Descriptive analyses were reported for patients with mania and with catatonic features.

Results: Of the original sample only 22 patients were excluded for the occurrence of side effects or
consent withdrawal. After the ECT course, 344 (68.8%) patients were considered responders (final CGIi
score ≤2) and 156 (31.2%) nonresponders. Response rates were respectively 68.1% for BD depression,
72.9% for mixed state, 75% for mania and 80.8% for catatonic features. Length of current episode and
global severity of the illness were the only statistically significant predictors of nonresponse.

Conclusion: ECT resulted to be an effective and safe treatment for all the phases of severe and drugresistant
BD. Positive response was observed in approximately two-thirds of the cases and in 80% of the
catatonic patients. The duration of the current episode was the major predictor of nonresponse. The risk of
ECT-induced mania is virtually absent and mood destabilization very unlikely. Our results clearly
indicate that current algorithms for the treatment of depressive, mixed, manic and catatonic states should
be modified and, at least for the most severe patients, ECT should not be considered as a “last resort”.

Abstract:Objective: We evaluated the effectiveness of Electroconvulsive Therapy (ECT) in the
treatment of Bipolar Disorder (BD) in a large sample of bipolar patients with drug resistant depression,
mania, mixed state and catatonic features.

Method: 522 consecutive patients with DSM-IV-TR BD were evaluated prior to and after the ECT course.
Responders and nonresponders were compared in subsamples of depressed and mixed patients.
Descriptive analyses were reported for patients with mania and with catatonic features.

Results: Of the original sample only 22 patients were excluded for the occurrence of side effects or
consent withdrawal. After the ECT course, 344 (68.8%) patients were considered responders (final CGIi
score ≤2) and 156 (31.2%) nonresponders. Response rates were respectively 68.1% for BD depression,
72.9% for mixed state, 75% for mania and 80.8% for catatonic features. Length of current episode and
global severity of the illness were the only statistically significant predictors of nonresponse.

Conclusion: ECT resulted to be an effective and safe treatment for all the phases of severe and drugresistant
BD. Positive response was observed in approximately two-thirds of the cases and in 80% of the
catatonic patients. The duration of the current episode was the major predictor of nonresponse. The risk of
ECT-induced mania is virtually absent and mood destabilization very unlikely. Our results clearly
indicate that current algorithms for the treatment of depressive, mixed, manic and catatonic states should
be modified and, at least for the most severe patients, ECT should not be considered as a “last resort”.